Difficulty and strategy of treatment for dental patients with epilepsia

Introduction

Patients with epilepsia presented the particular category among dental patients. It deals with possible provocation of status epilepticus in dental clinic or hospital by special attractors (bright light; loud noise; unexpected touching). According to international classification there are several types of epilepsia: generalized (primary total activation in nervous cells of brain) and focal (activation in separate group of some neurones) [1].

Concern to etiology, epilepsia include of idiopathic form (unknown etiology); symptomatic form (as a single symptom of other disease); genetic form [1, 2]. Beside that, there are 3 separate categories: progressive myoclonical epilepsy; encephalophaties from epilepsia; reflex epilepsies (idiopathic photosensitive occipital epilepsia that might be provocated by bright light; startle-epilepsia, which connected with loud, high-frequency noise, unexpected startle) [1, 2]. There are some special forms for every level of age. Type of treatment concern of age of epilepsia debut and form of manifestation (tonical, psycho-motorical, tonic-clonic form: grand mal — most difficult form). The focal reason of epilepsia pathogenesis provided by synchronized impulses in group of neurones towards to neurone cell membrane injury and disbalance between upload and down load polarized membrane's potential. It connected with influence of ion-target neurotransmitters: 4-aminobutanoic acid increased penetration of neurone cell membrane for chlor anions inside cell; N-methyl-D-aspartate have decreased penetration for natrium and calcium cations. Result of that is an effect of depolarization in intercellular stretch (increase of postsynaptic potential) [1].

Planning of most traumatic and long dental procedures (extraction of third molar teeth; reconstructive plastic surgery) necessary to provide in dental hospital with assistance of anesthesiologists and resuscitologists. It deals with possibility appearance of status epilepticus (long, often, exaggerated type of epilepsia manifestation) [1, 3, 4]. Duration of manifestation connect with decrease of 4-aminobutanoic acid and increase of N-methyl-D-aspartate influence, and afterwards rise up of calcium cations in liquor, that lead to tonic clonic muscle movements. It can be cause of aspiration pneumonia, also head and jaws injures, fractures of teeth [1, 4, 5].

Aim of study: Improve prosthetic dental supervision among patients with epilepsia.

Materials and methods

During the period of time from 2017 to 2019 — 7 patients with epilepsia in age of 20—45 years old was examined. They suffered from night-time bruxism; non of deal with epilepsia manifestations. Patients marked pain symptoms in area of ears and area of m.masseter from both sides. Bruxism was compilated with pathologic movements of single molars, premolars. Palpation appeared absence of masticatory muscles hypertrophia. There was multiple fractures of teeth; hard fractured teeth was extracted initially. And afterwards the solid acrylic mouthguards on low jaw (splints) was completed for all patients. Splints was necessary to use in whole night-time period and about 2—3 hours during the day. Dynamic control for patients appeared from 3-months period [6—8].

For registration masticate force (force of bite) and level of periodont resistance gnatodynamometry was used. If level of strength in bite of frontal teeth was under 50 N (Newton) it was diagnosed as temporo-mandibular joint disfunction. Throughout procedure it's needed for patients to be relaxed with some kind of comfortable feeling. Gnatodynamometry was examined preliminary and 3 months after treatment. According to this superficial electromyography at m.masseter area was used too. The first electrode was localized on border between upper and middle part from angle of mandible to foramen auricularis. The second electrode was located beside and lower the first one. It was 5-minute recording from both sides. Afterwards, the amplitude of tone (spontaneous) activity of impulse in rest position was verified. Examination was also before and after 3 months of splint-therapy (solid acrylic mouthguard on lower jaw, Fig. 1) [9—13].

Due to period of 3 months — capacity for structural, stabilized changes of muscle adaptation will appeared. This dynamic biochemical aspects concern with muscle metabolism, increase of numbers of mitochondria in muscle cells and ATP (adenosine triphosphate) production [14, 15].

Results

After 3 months mouthguard treatment the level of points in gnatodynamometry in frontal teeth verified increased level compared to level at the beginning (33.9±2.4; 45.1±1.8 N). The significant distinction in numbers of superficial electromyography was not indicated. Intuitively, the patients marked evaporation of headache and ache symptoms in locale of ears.

Conclusion

G.N. Krijanovskiy marked, that rise up the points of pathological system lead to their more higher level of resistance compared to complex contain from just 2 points. It appears in epileptic complex very clearly. Range of resistance inside pathological system able to turn out to be higher level of resistance towards to their long-term manifestation. The particular kind of pathological system concerned with licks of their parts that might be more exaggerate. Therefore, for result of pathological system to be erasure — the blocking of primary point could be not adequate [16, 17].

The structural organization of pathological and physiological (functional) system are distinguished actually. By terms of P.K. Anohin (1973), the functional system contains of dynamically mobilized structures in whole. The functional principle of separate mobilisation of structures is able to be dominated. In any case, without exception, physiological system is actual functional system [18, 19].

According to principles of A.M. Vein (1998), that concerned with psychoneurological reactions: the healthy human is often able to reacted separately; it determined by psychophysiological pattern; and in case of illness — it determined by diffusal, non control activation of all psychovegetative patterns. It could be as well on higher levels (cerebral vegetative reactions) as on lower levels (facial and trigeminal nervous activity, for pattern teeth grinding) [20—25]. The better level of points in gnatodynamometry might inform about some sort of local normalization in temporo-mandibular joints and partly in masticatory muscles. The absence of significant verification in numbers of superficial electromyography apparently due to impossibility of blocking the primarily dominant points in subcortical structures and in trigger-points of masticate muscles [26—28].

Recommendation for pharmacological therapy (antiepilept. Topiramat in rus. pharm.) should be proscribed by prescription very carefully. The prosthodontic splint (solid acrylic mouthguard) must to be covering for all teeth and alveolar parts absolutely. Using the face bow and registers of bite in central occlusion is needed to be for sure [29—32].

Dental patients with epilepsia also are needed to provide examination with control of splint condition (appearance of some balance, defects) — 1 time for each 3 months; the cone beam computed tomography and MRI ought to be presented: for control of treatment [33—37].